Stroke Flashcards by Sarah-Louise Watson

Definition of a stroke

A condition characterized by rapidly progressive clinical symptoms and signs of focal and at times global, loss of cerebral function lasting more than 24 hours or leading to death with no apparent cause other than vascular origin

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What are the types of stroke

Ischaemia stroke = 70-80%

- Haemorrhagic stroke = 20-30%

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describe some epidemiology of stroke

Common
Every 5 minutes someone has a stroke
Prevalence 5/1000
Incidence 2/1000
8% of deaths
1/3 die within a year, most within 4 weeks
Most than three times as many women die from stroke than breast cancer in the UK
Leading cause of severe disability

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what is the leading cause of severe disability

Stroke

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what are the mechanisms by which an intracerebral haemorrhage occurs

Charcot-Bouchard microaneurysms
Microbleed
Haemorrhagic transformation of infarcts
Vasculitis

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What are the primary and secondary causes of intracererbal haemorrhage

Primary
- Hypertension (microaneurysm)

Secondary

Trauma
Tumour
AV malformation
Venous thrombosis
Drugs
Vasculitis
Coagulopathy

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name some complications that can occur with intracerberal haemorrhage

Local damage
Local mass effect/herniation – if the haematoma is large enough, can cause subfalcine herniation or tentorial or tonsillar herniation
Raised ICP – causes brain perfusion to fall (CPP) and leads to ischemia and hypoxia
Hydrocephalus – if there is an outflow obstruction caused by the stroke, this causes the ventricles to expand and the brain matter to be squashed

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describe the management that is used in stroke

Establish cause – imaging/angiography, clotting/platelet function
Stop aspirin or warfarin
Treat complications ICP management, Surgery/EVD
Treat risk factors – blood pressure
Rehabilitation
Role of pro-coagulants
Role of surgery
Role of aggressive BP lowering – overall advantage in gentle blood pressure lowering

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what are the two types of ishcemic stroke

thrombotic

embolic

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what type of ishcemica vessel stroke can occur

Large vessel stroke

* Small vessel stroke (lacunar).

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Describe how exncitoxcity can cause stroke

Glutamate excitocity
Ischemia leads to the failure of sodium and potassium pumps
This leads to depolarisation and the release of glutamate
Affects AMPA receptors causing slow excitoxity and NDMA receptors causing fast ecotoxicity
This causes influence of calcium via the NMDA receptors
Leads to elevated intracellular calcium which can cause the release of free radicals and cell death

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what is cerebral blood flow determined by

Cerebral perfusion pressure

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what are the 3 regions of the brain that focus around a stroke and what happens to the cells there

The centre – cells here face inventible death
The penumbra region – neurones are hypoxic and/or damaged but survival is possible
At a distance there are cells supplied by other arterial arteries or there is enough oxygen that pass through which keeps them alive

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What are the causes of ischaemic stroke

25% small vessel stroke – arterioathersclerosis
15% cardiac embolic due to AF – left atrial appendage, can cause an embolism, travels to the brain, occludes small blood vessels
5% carotid dissection
Atherosclerosis 50%= carotid stenosis 10% - important- surgery or alternative stenting
Vasculitis less than 1%
Haematological less than 1%

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What is the major cause of ischemic stroke

atherosclerosis

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What are the risk factors for stroke

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Demographic: age, male, race, socioeconomic status
Lifestyle: smoking, weight, inactivity, alcohol.

•	Medical:
o	Hypertension 
o	Hypercholesterolaemia
o	Diabetes 
o	Vascular disease
o	Cardiac
o	Rare Associations.

for every 1mm/L decrease in LDL there is a ….

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15% decrease in risk of stroke

What is the pyramidal system made up of

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Primary motor cortex 
 internal capsule 
 cerebral peduncles 
decussation of pyramids 
descending CS.

What happens if you have an ischemic stroke at any point along the pyramidal system

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• Ischemic stroke deficits at any point of this route motor deficits (e.g. MCA stroke).

how do you classify strokes

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By vascular anatomy = MRI, and CT
By clinical picture = the oxford bamford classification
By aetiology – The TOAST classification

what arteries in stroke cause visual defects

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PCA stroke

MCA stroke

describe the Oxford Bamford classification for

anterior circulation
posterior cinrcualtion
lacunar circulation

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Anterior circulation – TACI/PACI (15/35%)

Unilateral motor deficit
Homonymous hemianopia
Higher cerebral function (dysphasia, neglect)

Posterior circulation – POCI (25%)

Pure hemianopia
Cerebellar sgins
Diplopia and CN palsy
Bilateral/crossed sensory motor signs

Lacunar – LACI (25%)

Pure motor (50%)
Pure sensory (5%)
Ataxic hemiparesis (10%)
Sensorimotor stroke(35%)

what happens if you have stroke in the anterior circulation

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Unilateral motor deficit
Homonymous hemianopia
Higher cerebral function (dysphasia, neglect)

what happens if you have a stroke in the posterior circulation

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Pure hemianopia
Cerebellar sgins
Diplopia and CN palsy
Bilateral/crossed sensory motor signs

What happens if you have a stroke in the lacunar circulation

- Pure motor (50%) - Pure sensory (5%) - Ataxic hemiparesis (10%) - Sensorimotor stroke(35%)

name investigations that are carried out for stroke

- CT/MRI - blood - carotid doppler - ECG - Echo - HIV test - drug screen - Cather angiography - if there less than 50 years old consider vasculitis screen

what in a blood test do you look for stroke

``` o FBC o ESR o Fasting glucose o Cholesterol o VDRL ```

what treatment can be used for stroke

1. Consider thrombolysis 2. Transfer to a stroke unit 3. Receive antiplatlet therapy 4. Address risk factors 5. Treat complications 6. MDT rehabilitation 7. Advice and education

How many patients are suitable for thormbolysis

20% of patients are suitable for thrombolysis. | - usually works best within 3 hours of stroke, not effective after7 hours

What patients are suitable for a thrombecotmy

5% of patients are suitable for thrombectomy.

What is a thrombectomy

this is the removal of a clot from the Brain

what are the current guidelines for drug treatment of stroke

• Aspirin 300mg for 2/52 then Clopidogrel 75mg monotherapy OR • Aspirin 75mg + Dipyridamole MR 200mg BD

What is a TIA

- An acute loss of focal cerebral or monocular function with symptoms lasting less than 24 hours and which after adequate investigation is presumed to be due to embolic or thrombotic vascular disease

what is the ABCD2 score

- Age - Blood pressure - Clinical features - Duration - Diabetes

What can cause a TIA

- Usually ischaemia/embolic - Sometimes microbleeds - Rarely haemodynamic

describe what happens in TIA management

- CT - Doppler/CTA - ECG - Start Antiplatelets ```  Admit if  Atrial Fibrillation(unless FRT)  Carotid stenosis(for surgery)  >2 in 1 week(forIx)  ABCD2 >4 and no clinic in 24hrs ```  IfABCD2 <4 &none of above  Can refer to local TIA clinic

Stroke Flashcards

(36 cards)